2002-353 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
CER
I IFICATE OF COMPLIANCE
Permit Number: P20020353 Date Issued: Thursday,May 23,2002
This is to cert that work requested to be done as shown by Permit Number P20020353
has been completed,
Tax Map Number: 523400-302-014.0003-006.000.0000
Location: 27 LINDEN Ave
Owner: MICHAEL&KATHRYN HOFFMAN
Applicant: MICHAEL&KATHRYN HOFFMAN
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
Director of Building&Code En£o cement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20020353 Application Number: A20020353
Tax Map No: 523400-302-014-0003-006-000-0000
Permission is hereby granted to: MICHAEL &KATHRYN HOFFMAN
For property located at: 27 LINDEN Ave
in the Town of Queensbury,to construct or place
at the,above location in accordance with application together with plot plans and other information hereto filed
and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: MICHAEL&KATHRYN HOFFMAI`_ Septic Alteration Residential
2'7 LINDEN Ave QUEENSBURY,NY 12804 .Total Vaiue
Contractor or Builder's Name f Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans &Specifications
2002-353
SEPTIC ALTERATION AS PER APPLICATION
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday,May 08,2003
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the To of Quee bury; Wednesday,May 08,2002
SIGNED BYA for the Town of Queensbury.
Director of Buildin &Co Enforcement
- 516.745. 4437
� No.638 04,102 '02 Arl '•11 25 .:,I D:TOWN OF QUEENSBURY FAX:5I8 7745 4437 `';. PAGE 1
Application for'Permit—septic DIsippes.1,Sysit+am. -
Totivn of Queensbu7y 742 BcryRoad gueansbury,` IZ8o4'(SIB) 761-82-�6. —µN
1. O'WNER INFORMATION', / pltice.TJse .
Location of installatsori �AllNo J
Tax Map No. ee
Owner':Niuno: .........................
Address: %!� �Gy 1� .✓ \�1(. rf Ej�/S�
c! 2 O v�- �CO SHONE NO. �2 "7 ,Z, 7
2. INSTALLER.'S NAME t' �`! h✓
IN
3. RESIDENCE FORMATION (circle year of dwelling,indicate#bedroom(s) and multiply# of
bedrooms with applicable gallons per bedroom to equal'total daily flow)
Year or rseuee No'of Bgdree�ms (^Q,„t,tttation — " Total I?afly FlawFla�+�st
1980 or older
x 150 gal/bdrm s y��
1980-1991 ° x 130 gaVbdrm
1991—present: x 110 Sallbdrtn ..
Garbage Chinder Installed yes_ ! no
Spa or Whirlpool Installed yes, / no
4, PARCEL IIVFORMA.TION: (circle applicablo information 8a indicate measurements)
sa at what7depth' , what depth R Plling am.' feet' well
Steep slope ekry ewell;water s;::°pply
%;slope'. other.% from any septic-system
depth: absorption is f}•
other
percolation Test: '(To be completed by licensed professional engineer or architect}
Rate; minute per inch
S. PROP OSEDSY'STEM: war Nose Condon: All individual sewage disposal systortu.must be designed by a licensed
protirassian it ingineer or ar+Wtect.(unless insWlod in a Planning Hoard approved subd iton). Add 250 gallons to the size
of the septic tank.and leach field liar ouch Garbage Ch nder,Spa or Whirlpool Tub.
Septic Tank: &O—agcxilon(ruin. size 1,f1U0 gal.)
Tile Field: _each trench f? Total System Length: ` f?
Seepage Pita}: '.numbgr.of size of each: �fl by _
Sizo of Stone to be,used: # I depth or thickness feet,
Bed System Size``' x
Altom�iYe System: length and/or size
6. HOLDINNQ TANK SYSTEM: '(it required)
:ry
Number of tanks: /.Sie of each: gallons TOTAL Capacity: gallons
Notr: Alarm System said associated electrical work must be inspected by a Town approved
electrical inspection agency.
7. SIGNATURE 8c INFORMATION,FOR RESPONSIBLE PEON(please read) .
For your protection,please note that pursuant to Section 136-29-of the Code of the Town
of Queensbiiry,any.persnit,or approval granted-Which is based upon or is grained in
reliance upon any material rnisrepresentation or failure to'maka ss material fact or
circumstance known by or on behalf of tug applicant,,shall be void.
I have rea ie"Pr: lations with rasp e to this application cad agiee W,ubido.bytheme and all,
requir ofth Town of Queens unitary sewage Disposal OrdinanCo. y
ig a roof riespons , le.person O
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TOWN OF QUEENSBURY
BUILDING A CODE ENFORCEMENT
Qu4et--nsbuv-_y MY M2804
SEPY1C DISPOSAL SYSTEM IMSPEC-UION
N am e-
Date
P c--r-M i -t
SOIL TYPE_ Sa d Loam-Cl ay-
Rosul -ts C) 01 a-ti on -res-t-
( -1 -F applica Te-) Rate-to-Minu-te/Inch
TYPE OF SYS
AEtSORPTION F iD : -,Tatal Loncl-t
N
c S I -a
YS
d
L C)a a
a
-t 7t
14�1 ! --�T --7->
Length of" e-ac trench
Depth oV t�r-enc
C7
Size o-F s-tone
SEEPAGE PITS : N mbe
I
Size -t
Stone size
PIPING= )v- z- T
BI dg . to -rank
Tank to Dist - Box
Dis-t . Box to Field/
Openings Sealed ? No Par-ti al
t-OCA-T1OH/SEPARAYXO d.,
Foundation tQ T Tes---7t
Founda-tion to -Absc:)r-p-:ti n -Fc--4e-t - ,
Sepa-rat-lon atV - Pi -r-s -F em.
Conforms as per Plo-t P-1 n f e No
UOCAT17� YSYEM ON P OPERT
rk c ! r-cl
Ft-on t Lo-Ft Side Right Side
Middle Front Middl. e Rea
COF4?4EH-TS
SYSTEM . USE APPROVED -- YES
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SSURY
BUILLAG
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f—, 'eve 1 saw evidence oi,
`r1fIQ70/] , ear bel� fences, ec.
e seen or n seeded „,ells,truss
Silo 35
nc�.se�F
all�d,ec�s 5 r '1�n!• ' fis>l) rt:3i�s£?S'.I � j,�`r.� L11is�iUlil.
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